Abstract

Suicidal ideation in young adults is an increasingly burdensome issue worldwide. Further, previous research has shown a very high prevalence of suicidal ideation in medical students, ranging from 9.1% to 48.2%. Many factors have been identified as likely contributors to the development of suicidal tendencies in this specific population including certain behavioral and personality traits, co-existing mental health problems, and stressful personal or academic events. In addition, female medical students have been found to have significantly higher rates of suicidal ideation than the general population.

Keywords

Discussion

Suicidal ideation in young adults is an
increasingly burdensome issue worldwide.
Further, previous research has shown a very
high prevalence of suicidal ideation in medical
students, ranging from 9.1% to 48.2% [1-3]. Many factors have been identified as likely
contributors to the development of suicidal
tendencies in this specific population including
certain behavioral and personality traits, coexisting
mental health problems, and stressful
personal or academic events [4-6]. In addition,
female medical students have been found to have
significantly higher rates of suicidal ideation than
the general population [7,8].

The data shows that many factors contribute
to the high rates of suicidal ideation in medical
students. These students are more susceptible to
psychiatric stressors, and therefore have alarming
rates of burnout, anxiety, and depression
[9,10]. Depression in particular is frequently
documented as one of the risk factors most likely
to lead to suicidal thinking, and studies have shown that many students are depressed when
they commit suicide [11,12].

Other common traits that may contribute to
suicidal thoughts in medical students include
substance abuse, heavy curricular burdens,
decreased life satisfaction, and certain personality
traits including maladaptive behavior [4,13-15]. As data from a six-year longitudinal study
from four medical universities in Norway
demonstrate, medical students’ life satisfaction
drops precipitously at the start of their studies
and remains low until graduation [15]. Another
study performed in 2014 showed that medical
students are less likely to look after their personal
concerns and to seek mental health treatment
due to fears about stigmatization, confidentiality,
and any impact such treatment may have on
their future careers [5,16,17]. Additionally,
certain personality traits make medical students
more vulnerable to mental health stressors and
suicidal ideation. These include neuroticism,
introversion, and low self-esteem [18,19]. Several
previous studies have shown that low self-esteem,
which implies self-rejection, self-dissatisfaction, and self-contempt, is associated with suicidal
ideation [20]. Moreover, suicidal ideation has
been shown to be associated with low social
function scores (indicating a decrease in the
pursuit of social activities with family, friends,
or colleagues because of physical or emotional
constraints). One study, although not performed
on medical students, concluded that social
functioning may have a major impact on suicidal
ideation [20]. In the meantime, students with
suicidal ideation score no differently than normal
students on a battery of neuropsychological
tests (Wisconsin Card Sorting Test, executive
function; Auditory Verbal Learning Test,
verbal learning and memory; Word Fluency
Test, verbal fluency; Trail Making Test, visualmotor
processing and motor speed; Stroop Test,
response inhibition and selective attention).

The strong association between mental health
and suicidal ideation has been emphatically
pronounced on the research level, yet this has
not yet translated to a similar interest among
medical educators [5,21]. Perhaps if researchers
place a greater emphasis on the specific risk
factors associated with suicidal ideation and
the respective preventative programs aimed to
combat such risk factors, this would generate
more enthusiasm for prevention amongst
medical educators. For example, the integration
of stress coping strategies into a medical
curriculum could be taken on as an attempt to
combat school related pressures.

In recent years, integrated medical curricula
aimed at improving the well-being of medical
students have gained popularity in some
countries. These initiatives have focused on
students’ mental health, improving antiquated
curricular structures, and offering systemic support. One example is the Vanderbilt Medical
Student Wellness Program, which had its origins
in the Vanderbilt Wellness Program established
in 2005. This program has received positive
feedback and responses from students.

What’s next?

Such kind research is still progressing, but one
direction it seems to be heading is the conflict
between the vast amount of research on the topic
and the lack of response from medical schools
to combat suicidal ideation. One would think
that with all of that evidence and all of that
suffering, medical schools would be very quick
to jump on board to establish new prevention
programs. Why haven’t they? Is it because they
lack the resources, because they do not believe
the literature, because they are engrained in old
ways of teaching (some schools have curricula
that haven’t changed for decades) or thinking
(some doctors feel medical students and residents
should go through a period of “suffering” as an
initiation to becoming a doctor and also because
they had to do it), or some other reason?

Another potential direction to go is the point
that students with suicidal tendencies score no
different on testing than normal students. Why
is this so? Is it only neuropsychiatric testing or is
it also medical school examinations? One would
intuitively believe that a depressed student might
have harder time studying for exams than a
normal student and be therefore more likely to
fail, but perhaps there are other factors at play.
One would also expect that depressed students
would score drastically different on neuropsych
testing than normal students, but again perhaps
there are other factors at play.

Mojs E, Warchoł-Biedermann K, Głowacka MD, et al. Are students prone to depression and suicidal thoughts? Assessment of the risk of depression in university students from rural and urban areas. Ann. Agric. Environ. Med 19(4), 770-774 (2012).

Mitsui N, Asakura S, Shimizu Y, et al. The association between suicide risk and self-esteem in Japanese university students with major depressive episodes of major depressive disorder. Neuropsyhiatr. Dis. Treat 10(1), 811-816 (2014).